Skip header and navigation

2 records – page 1 of 1.

Eligibility for organ donation: a medico-legal perspective on defining and determining death.

https://arctichealth.org/en/permalink/ahliterature149821
Source
Can J Anaesth. 2009 Nov;56(11):851-63
Publication Type
Article
Date
Nov-2009
Author
Jocelyn Downie
Matthew Kutcher
Chantelle Rajotte
Alison Shea
Author Affiliation
Faculty of Law, Dalhousie University, 6061 University Avenue, Halifax, NS, B3H 4H9, Canada. jocelyn.downie@dal.ca
Source
Can J Anaesth. 2009 Nov;56(11):851-63
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Canada
Death
Health Policy - legislation & jurisprudence
Heart Arrest - physiopathology
Humans
Legislation, Medical
Organ Transplantation - legislation & jurisprudence
Tissue Donors - legislation & jurisprudence
Tissue and Organ Procurement - legislation & jurisprudence
Abstract
In the context of post-mortem organ donation, there is an obvious need for certainty regarding the legal definition and determination of death, as individuals must be legally pronounced dead before organs may be procured for donation. Surprisingly then, the legal situation in Canada with regard to the definition and determination of death is uncertain. The purpose of this review is to provide anesthesiologists and critical care specialists with a medico-legal perspective regarding the definition and determination of death (particularly as it relates to non-heart-beating donor protocols) and to contribute to ongoing improvement in policies, protocols, and practices in this area.
The status quo with regard to the current legal definition of death is presented as well as the criteria for determining if and when death has occurred. A number of important problems with the status quo are described, followed by a series of recommendations to address these problems.
The legal deficiencies regarding the definition and determination of death in Canada may place health care providers at risk of civil or criminal liability, discourage potential organ donation, and frustrate the wishes of some individuals to donate their organs. The definition and criteria for the determination of death should be clearly set out in legislation. In addition, the current use of non-heart-beating donor protocols in Canada will remain inconsistent with Canadian law until more persuasive evidence on the potential return of cardiac function after cardiac arrest is gathered and made publicly available or until a concrete proposal to abandon the dead donor rule and amend Canadian law is adopted following a process of public debate and intense multidisciplinary review.
Notes
Comment In: Can J Anaesth. 2009 Nov;56(11):789-9219711143
PubMed ID
19585180 View in PubMed
Less detail

Pre-mortem transplantation optimizing interventions: the legal status of consent.

https://arctichealth.org/en/permalink/ahliterature156392
Source
Can J Anaesth. 2008 Jul;55(7):458-69
Publication Type
Article
Date
Jul-2008
Author
Jocelyn Downie
Chantelle Rajotte
Alison Shea
Author Affiliation
Faculty of Law and Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. jocelyn.downie@dal.ca
Source
Can J Anaesth. 2008 Jul;55(7):458-69
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Canada
Clinical Protocols - standards
Consent Forms - legislation & jurisprudence
Death
Humans
Informed Consent - legislation & jurisprudence
Practice Guidelines as Topic - standards
Tissue Donors - legislation & jurisprudence - supply & distribution
Tissue and Organ Procurement - legislation & jurisprudence - methods
Transplantation - legislation & jurisprudence - standards
Abstract
The focus of this paper is on consent issues surrounding pre-mortem transplantation optimizing interventions. First, we explore the potential consequences of the different types of pre-mortem transplantation optimizing interventions that might be used, and we examine the current Canadian practice with respect to these interventions. We then analyze the status of consent to pre-mortem transplantation optimizing interventions under the current legal framework. Finally, we provide recommendations on how to improve the current legal framework.
In Canada, as in many countries in the world today, there is a shortage of organs available for transplantation. Canada's deceased donor rate was 12.8 per million in 2005, a rate that has been stable over the past 12 years. At the end of 2005, the number of Canadians on waiting lists for an organ was 4,025 (125 out of every million Canadians). In total, 283 patients died in 2005 while waiting for new organs. To address the shortage of available organs, a number of changes have recently been made to organ donation practices and protocols. The use of pre-mortem transplantation optimizing interventions is a significant issue in organ donation, and it has become increasingly important to reflect on the use of such interventions, in light of these new practices. "Pre-mortem transplantation optimizing interventions" are interventions that are carried out on a patient, before his or her death, for the purpose of optimizing the chances of successful transplantation.
We argue that consent is legally required and must be express and competent patients have the legal authority to consent; but the law with respect to legal authority to consent on behalf of incompetent patients varies across the country. We come to the unsettling conclusion that the legality of pre-mortem transplantation optimizing interventions in many circumstances is at best questionable. We provide concrete recommendations (draft statutory text) on how to improve the current legal framework.
PubMed ID
18591704 View in PubMed
Less detail